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General NPI Number Information
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NPI Number | 1487159919
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Entity Type | Organization
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Legal Business Name | IMPACT 4 CHANGE
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Dates
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Enumeration Date | 03/27/2018
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Last Update Date | 03/27/2018
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Provider Practice Location Address
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Address Line | 13810 CHAMPION FOREST DR STE 203
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City | HOUSTON
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State | TX
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Zip | 77069-1875
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Country | US
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Telephone | 713-231-6801
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Fax |
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Provider Business Mailing Address
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Address Line | 2718 MARSHWOOD RD
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City | HOUSTON
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State | TX
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Zip | 77038-1122
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Country | US
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Telephone | 713-231-6801
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | CATHERINE MUKES
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Credential | LPC
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Telephone | 713-231-6801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State | TX
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